Provider Demographics
NPI:1780850842
Name:PRECIADO, ALVARO (DDS)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:PRECIADO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214-30 46 AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:347-235-4100
Mailing Address - Fax:
Practice Address - Street 1:447 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5207
Practice Address - Country:US
Practice Address - Phone:718-875-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177141223G0001X
NY0531081223G0001X
CT0097021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02802748Medicaid